Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands.
Vox Sang. 2013 Oct;105(3):236-43. doi: 10.1111/vox.12036. Epub 2013 Jun 19.
Pregnant women with Idiopathic thrombocytopenic purpura (ITP) can deliver neonates with severe thrombocytopenia. Clear evidence declaring the pathophysiological cause of this neonatal thrombocytopenia is lacking, as antiplatelet antibodies are not always detectable in maternal serum. Severe neonatal thrombocytopenia below 50 × 10(9) /l is reported in 8-13% of the neonates from mothers with ITP and intracranial haemorrhage (ICH) in 0-2·9%. Evidence about the optimal postnatal treatment is scarce. Our objective was to evaluate the outcome and management in neonates with passive ITP.
All neonates from mothers with ITP born between 1980 and 2011 were included. Platelet counts during the first 10 days, presence of ICH and postnatal treatment were recorded. Maternal characteristics were analysed as possible risk factors for severe neonatal thrombocytopenia.
Sixty-seven neonates were included. Severe thrombocytopenia (<50 × 10(9) /l) occurred in 20/67 (29·9%) neonates. In three neonates, platelet count rose spontaneously, 18 neonates were treated (one with persistent moderate thrombocytopenia) with the following: platelet transfusions (3), prednisone (2), intravenous immunoglobulin (IVIG) (1), platelet transfusions and IVIG (11), platelet transfusion and prednisone (1). Recurrence of low platelet counts after transfusions was commonly seen. Risk factors for severe neonatal thrombocytopenia were a previous sibling with severe thrombocytopenia and low maternal platelet nadir during pregnancy.
In this cohort, severe neonatal thrombocytopenia occurs more frequently than previously reported. To maintain a platelet count above 50 × 10(9) /l, often multiple transfusions and IVIG are required. Multiple transfusions may be avoided by starting IVIG, when platelet count falls below 50 × 10(9) /l after the first platelet transfusion.
特发性血小板减少性紫癜（ITP）孕妇可产下严重血小板减少的新生儿。尽管母体血清中并不总能检测到抗血小板抗体，但缺乏明确证据表明这种新生儿血小板减少症的病理生理原因。据报道，8-13%的 ITP 母亲的新生儿血小板计数严重低于 50×10(9)/l，颅内出血（ICH）发生率为 0-2·9%。关于最佳产后治疗的证据很少。我们的目的是评估患有被动 ITP 的新生儿的结局和治疗方法。
纳入 1980 年至 2011 年间所有 ITP 母亲所生的新生儿。记录了新生儿出生后前 10 天的血小板计数、ICH 的发生情况以及产后治疗情况。分析了母体特征，作为新生儿严重血小板减少的可能危险因素。
共纳入 67 例新生儿。20/67（29.9%）新生儿发生严重血小板减少症（<50×10(9)/l）。3 例新生儿血小板计数自发升高，18 例新生儿接受了以下治疗：血小板输注（3）、泼尼松（2）、静脉注射免疫球蛋白（IVIG）（1）、血小板输注和 IVIG（11）、血小板输注和泼尼松（1）。输注后血小板计数再次降低的情况很常见。新生儿严重血小板减少的危险因素为：同胞曾有严重血小板减少症，以及孕妇血小板最低值低。
在本队列中，严重新生儿血小板减少症的发生率高于以往报道。为了维持血小板计数高于 50×10(9)/l，通常需要多次输注血小板和 IVIG。当第一次血小板输注后血小板计数低于 50×10(9)/l 时，开始 IVIG 治疗可能会避免多次输注血小板。
